Personality in multiple sclerosis (MS): impact on health, psychological well-being, coping, and overall quality of life

Personality traits in patients with multiple sclerosis: their association with nicotine dependence and polypharmacy

Background

The modifiable risk factor exerting the most substantial influence on the development and disease course of multiple sclerosis (MS) is cigarette smoking. Furthermore, smoking is associated with a higher risk of suffering from one or more comorbidities and potentially contributes to polypharmacy. We aimed to use personality tests to explore health-promoting and harmful patient characteristics.

Objective

To investigate two important factors influencing the course of MS - the degree of smoking dependence and the status of polypharmacy - in association with personality traits.

Design

This is a bicentric, cross-sectional study.

Methods

We collected sociodemographic, clinical and medical data from patients with MS (n = 375) at two German neurological clinics. The participants were asked to complete the NEO Five-Factor Inventory (NEO-FFI) and the Temperament and Character Inventory-Revised (TCI-R). Relationships between variables were examined using correlation analyses, and differences between groups were examined using linear models. Current smokers with MS were also asked to complete the Fagerström questionnaire to categorize them into patients with mild, moderate and severe smoking dependence.

Results

In our sample, 67.5% were women, and the mean age was 48.1 years. The patients had a median Expanded Disability Status Scale of 3.0 at a median disease duration of 10 years. Patients with MS with severe smoking dependence had on average a significantly higher neuroticism score in the NEO-FFI compared to those with mild or moderate smoking dependence. Patients with MS and polypharmacy had significantly higher neuroticism scores than those without. In the extraversion scale of the NEO-FFI, patients with MS and polypharmacy had significantly lower scores on average. Significant differences were also found when analysing the TCI-R in patients with MS and heavy smoking dependence, with higher scores for harm avoidance (HA) and lower scores for reward dependence, self-directedness (S-D) and cooperativeness (CO) in various subscales. Polypharmacy in patients with MS was associated with higher scores for HA and self-transcendence. Furthermore, patients with polypharmacy showed lower values than patients without polypharmacy in individual subscales of the dimensions of persistence, S-D and CO.

Conclusion

Using the NEO-FFI, we were able to show that neuroticism is a detrimental trait and extraversion a protective trait in patients with MS in relation to nicotine dependence and polypharmacy. In addition, the evaluation of the TCI-R showed that high HA as well as low S-D and CO scores were more common in patients with MS and nicotine dependence or polypharmacy. With this knowledge, the risk of polypharmacy and smoking can be understood in the context of personality characteristics and targeted treatment and counselling can be provided.

Neuroticism as a Common Factor in Depression and Anxiety Associated with Multiple Sclerosis-A Systematic Review and Meta-Analysis

BACKGROUND

Left undiagnosed and untreated, the association between multiple sclerosis and mental health difficulties significantly increases the multimorbidity risk in these patients. Hence, the purpose of this systematic review and meta-analysis was to estimate the prevalence of neuroticism, depression, and anxiety in MS and to explore the cumulative impact of these psychological factors on the disease expression.

METHODS

A literature search was conducted on PubMed, Web of Science, Scopus, and Google Scholar databases, according to the PRISMA guidelines. Also, the potential risk of bias was assessed using the AXIS tool.

RESULT

After a rigorous full-text examination, among the 756 identified studies, 22 investigations were considered for the systematic review, and 10 studies were selected for the meta-analysis. The prevalence of neuroticism in the studied population was 24.06% (95% CI: 16.79-33.34), of depression 20.77% (95% CI: 7.67-33.88), while the presence of anxiety was found in 23.94% (95% CI: 6.21-40.36).

CONCLUSIONS

The main finding of this research confirms that psychiatric disorders often co-occur with MS, impacting the clinical symptoms and life quality of patients living with this illness. For a better understanding of the interaction between personality, depression, anxiety, and the disease symptoms, future research should consider conducting comparisons on more homogenous studies.

The influence of personality in persons with MS

BACKGROUND

Comprehending the influence of personality traits on functional outcomes in persons with Multiple Sclerosis (pwMS) can aid in tailoring interventions and support strategies. We explored how demographic variables and personality traits predicted current vocation, information processing speed, anxiety and depression symptoms, and disability level in pwMS.

METHODS

We used a retrospective chart review on pwMS treated at the London (ON) MS Clinic, that assessed demographic data and personality traits. Participants were 384 (68.8 % females, mean age of 37.8, SD = 10.4) individuals with relapsing and primary progressive MS. We performed hierarchical linear regressions to predict outcomes while considering demographic variables and personality traits.

RESULTS

Younger age, higher education, and conscientiousness were significant predictors for better information processing speed, current vocation, depression symptoms, and disability level. Neuroticism was positively associated with anxiety and depression symptoms, while extraversion was negatively associated with depression symptoms. Women showed higher anxiety symptoms, while men showed higher depression symptoms.

CONCLUSION

Personality traits, such as neuroticism and conscientiousness, influence psychological outcomes in pwMS. Younger age and higher education are associated with better functional outcomes. Thus, when considering personality traits, future interventions should focus on those with higher neuroticism and lower scores on both extraversion and conscientiousness. Consideration of social support, coping strategies, and disease severity in future research may further enrich our understanding of MS outcomes.

Assessment of Functional and Dysfunctional Perceived Threat of Hate Crimes Among Persons With and Without Disability

This study examined the relationship between disability status and perceived threat of hate crimes. Building on existing conceptual frameworks, first we differentiated between dysfunctional perceived threat that damages quality of life and functional perceived threat that has the capacity to be motivational and precautionary. We then examined how disability status predicts individuals' threat memberships across dysfunctional and functional perceived threats of hate crimes. Results-based on a survey of 1,824 adults recruited from Amazon's Mechanical Turk-indicate that persons with a disability are more likely than those without a disability to exhibit dysfunctional perceived threat (vs. functional or no perceived threat) of hate crime across different bias motivations. This relationship was evident even when accounting for those most at risk for each type of hate crime (e.g., persons of color for anti-race/ethnicity hate crime). Further, persons with cognitive and physical disabilities were associated with higher odds of dysfunctional perceived threat of all types of hate crimes when compared to persons without a disability. Overall, the present study highlights that persons with a disability may experience exacerbated consequences of subjective threat of hate crimes. Findings also suggest the importance of an intersectional approach to hate crime by considering how disability may intersect with other forms of oppression in relation to perceived threat of hate crime. Implications and future directions, especially as they relate to measurement, are discussed.

Positive Psychological Well-Being in Hematopoietic Stem Cell Transplantation Survivors

Positive thoughts and emotions contribute to overall psychological health in diverse medical populations, including patients undergoing HSCT. However, few studies have described positive psychological well-being (eg, optimism, gratitude, flourishing) in patients undergoing HSCT using well-established, validated patient-reported outcome measures. We conducted cross-sectional secondary analyses of baseline data in 156 patients at 100 days post-HSCT enrolled in a randomized controlled trial of a psychological intervention (ClinicalTrials.gov identifier NCT05147311) and a prospective study assessing medication adherence at a tertiary care academic cancer center from September 2021 to December 2022. We used descriptive statistics to outline participant reports of positive psychological well-being (PPWB) using validated measures for optimism, gratitude, positive affect, life satisfaction, and flourishing. The participants had a mean age of 57.4 ± 13.1 years, and 51% were male (n = 79). Many, but not all, participants reported high levels of PPWB (ie, optimism, gratitude, positive affect, life satisfaction, and flourishing), defined as agreement with items on a given PPWB measure. For example, for optimism, 29% of participants did not agree that "overall, I expect more good things to happen to me than bad." Aside from life satisfaction, mean PPWB scores were higher in the HSCT population than in other illness populations. Although many patients with hematologic malignancies undergoing HSCT report high levels of PPWB, a substantial minority of patients reported low PPWB (i.e., no agreement with items on a given PPWB measure). Because PPWB is associated with important clinical outcomes in medical populations, further research should determine whether an intervention to promote PPWB can improve quality of life in HSCT recipients.

Personality Traits and Fatigue in Multiple Sclerosis: A Narrative Review

(1) Background: Multiple sclerosis (MS) is a chronic neurodegenerative autoimmune disease. Fatigue is a prevalent and debilitating symptom that significantly impacts the quality of life of these patients. A relationship between personality traits and fatigue in MS has been hypothesized but not clearly defined. (2) Methods: A literature search was carried out from databases up to April 2023 for studies correlating personality traits and fatigue in patients suffering from MS. (3) Results: A total of ten articles was included; most of the studies depict a neuroticism-fatigue correlation; however, they were not consistent in terms of the fatigue, personality, and covariate assessments. (4) Conclusions: The clinical and methodological heterogeneity of the included studies prevented us from drawing any firm conclusion on the link between personality traits and fatigue in MS. Several models of personality and different fatigue assessments have been found. Despite this, a common pathway shows that the neuroticism trait or similar personality patterns has a role in fatigue diagnosis. This may be a useful target to improve the quality of life and enhance the modification of the disease treatment results. Further homogeneous and longitudinal studies are needed.

Investigating Relationships Among Interoceptive Awareness, Emotional Susceptibility, and Fatigue in Persons With Multiple Sclerosis

BACKGROUND

Fatigue is a particularly debilitating symptom for people with multiple sclerosis (MS). Although personality traits and MS have been studied, interoception and emotional susceptibility and their links to fatigue have not yet been explored.

METHODS

Study participants provided demographic information and completed standardized patient-reported outcomes of walking function, physical activity, subjective fatigue, interoceptive awareness, and emotional susceptibility. A subset of participants participated in semistructured interviews discussing fatigue, body sensations, emotions, and their effects on exercise. Quantitative data were analyzed using multiple regression. Qualitative data were analyzed using thematic analysis.

RESULTS

Mean ± SD Fatigue Severity Scale scores (5.0 ± 1.3) indicated that fatigue was a problematic symptom. Mean ± SD Multidimensional Assessment of Interoceptive Awareness, Version 2 (2.8 ± 0.6) and Emotional Susceptibility Scale (3.0 ± 1.0) scores indicated lower levels of interoceptive awareness and emotional susceptibility. Quantitative data indicated no relationship between fatigue and interoceptive awareness (β = -0.20; P = .88) and emotional susceptibility (β = 0.03; P = .83), and neither were these related to physical activity (β = -0.07; P = .64). Qualitative themes indicated strong fatigue experiences involving the whole body and individual limbs, anger and frustration, and effects on physical activity.

CONCLUSIONS

Physically active people with MS report strong sensations of fatigue closely linked to frustration and helplessness. There was agreement between qualitative and quantitative assessments of fatigue but dissonance regarding interoceptive awareness and physical activity. The practice of clinicians, particularly those involved with facilitating or planning physical activity for persons with MS, would benefit from these findings about fatigue.

Personality as a Predictor of Disability in Multiple Sclerosis

OBJECTIVE

As personality changes and personality disorders are frequently observed in multiple sclerosis (MS), personality may be a prognostic factor for this disease. The present study investigated the influence of personality on disability, progression, and treatment adherence in MS.

METHOD

Personality was assessed in 41 patients with Relapsing-Remitting MS (30 females; mean age = 42.63 years) using the NEO Personality Inventory-3rd edition. Disability was measured with the Expanded Disability Status Scale, and treatment adherence information was collected from the Swiss MS Cohort. Correlation, multiple linear and partial least square regressions were performed to examine relations between personality, disability, and treatment adherence in MS.

RESULTS

After accounting for age and time since disease onset, our analysis revealed that Neuroticism (β = 0.32, p = 0.01) and its Vulnerability facet (β = 0.28, p < 0.05) predicted greater disability, whereas Extraversion (β = -0.25, p = 0.04) and its Activity facet (β = -0.23, p < 0.05) predicted milder disability. Regarding disability progression, correlational analysis revealed that it was negatively correlated with Extraversion (r = -0.44, p = 0.02) and the Feelings facet of Openness (r = -0.41, p = 0.03), but regressions failed to highlight any predictive links. No significant results could be demonstrated for treatment adherence.

CONCLUSIONS

Overall, our study showed that some personality traits can impact disability in MS, indicating that these should be considered in clinical practice, as they could be used to adapt and improve patients' clinical support.

Keeping it together: The role of social integration on health and psychological well-being among individuals with multiple sclerosis

Research indicates that people with multiple sclerosis (MS) are more likely to report poorer health and well-being than their peers without MS. Fortunately, it is also known that an individual's social and lifestyle factors play a great role on maintaining and promoting one's health and overall well-being. The present study aimed to examine the role that social integration and social support, in particular have on health and psychological well-being (PWB) among individuals with MS. One hundred and eighty three individuals with MS completed measures of social and lifestyle factors, personality, physical and mental health, MS disease symptomatology and PWB. Cross sectional, regression analyses were conducted to determine the role of social and other lifestyle factors (e.g., diet/exercise) on health and PWB. A subset of this sample (108) completed a follow-up assessment. Longitudinal analyses of this sample were also conducted. Consistent with previous findings, the presence of social integration and social support were significant predictors of health and PWB even when taking into account other lifestyle factors (i.e., diet/exercise, substance use, smoking), cardiovascular risk, demographics (i.e., gender, age, education, relationship status) and personality. The role of social integration and support on health and PWB is well established. Present findings confirmed these associations among individuals with MS. These findings suggest that social integration and social support should be a crucial part of MS management and that further interventional studies aimed at improving social integration and reducing social isolation are warranted in an effort to promote and maintain overall health and well-being.

Contact patterns and costs of multiple sclerosis in the Swedish healthcare system-A population-based quantitative study

BACKGROUND

The burden of disease for persons with multiple sclerosis (MS) and society is changing due to new treatments. Knowledge about the total need for care is necessary in relation to changing needs and new service models.

OBJECTIVE

The aim of this study was to describe the contact patterns for MS patients, calculate costs in health care, and create meaningful subgroups to analyze contact patterns.

METHODS

All patients diagnosed with MS at Ryhov Hospital were included. All contacts in the region from January 1, 2018, until September 30, 2019, were retrieved from the hospital administrative system. Data about age, sex, contacts, and diagnosis were registered. The cost was calculated using case costing, and costs for prescriptions were calculated from medical files.

RESULTS

During the 21-month period, patients (n = 305) had 9628 contacts and 7471 physical visits, with a total cost of $7,766,109. Seventeen percent of the patients accounted for 48% of the visits. The median annual cost was $7386 in the group with 10 or fewer visits, compared to $22,491 in patients with more than 50 visits.

CONCLUSION

There are considerable differences in the utilization of care and cost between patients with MS in an unselected population, meaning that the care needs to be better customized to each patient's demands.

The Big Five Personality Traits and Positive Orientation in Polish Adults with Multiple Sclerosis: The Role of Meaning in Life

Scientific achievements concerning the direct relation between personality traits and positive orientation among patients with multiple sclerosis do not explain the role of potential mediators. In fact, some researchers argue that the traits–positivity association is much more complex than it seems to be. For this reason, we made an attempt to analyze the indirect relationship between the above-mentioned variables, including meaning in life as a mediator. In total, 618 patients with MS took part in the study. The NEO Five-Factor Inventory, the Positive Orientation Scale, and the Meaning in Life Questionnaire were used. The results showed that positive orientation/the presence of meaning/searching for meaning correlated positively with extraversion, openness to experience, agreeableness, and conscientiousness, and were negatively associated with neuroticism. Moreover, meaning in life in both its dimensions acted as a mediator in 9 of 10 models. It can be assumed that a propensity to establish interpersonal relationships (extraversion), use active imagination (openness), inspire confidence among others (agreeableness), and take responsibility (conscientiousness) can have an impact on someone’s positive attitude toward oneself and the surrounding world (positive orientation) when people have meaning in life and when they are seeking it.

Surviving a global pandemic: The experience of depression, anxiety, and loneliness among individuals with multiple sclerosis

Background

The world has been experiencing one of the most significant worldwide health pandemics in modern history. The result has been increased depression, anxiety, and loneliness in the general population. However, populations who demonstrated pre-pandemic emotional disturbance and social isolation, such as individuals with multiple sclerosis (MS), are likely uniquely vulnerable to such symptoms.

Objective

The purpose of the present investigation was to examine the emotional outcomes, including reports of loneliness, in individuals with MS during the COVID-19 pandemic. We additionally sought to examine how individuals’ experiences during the pandemic may contribute to a specific COVID-19-related depression or anxiety.

Methods

142 individuals with MS who previously participated in a national, online, survey-based study were asked to complete an online survey assessing their current level of depression, anxiety, loneliness, and perceived impact of the COVID-19 pandemic.

Results

Increases in the rates of depression and anxiety were noted, with approximately 54% and 33% reporting “new” depression or anxiety, respectively. Given this increase, we examined how individuals with “new” depression or anxiety differed from those without depression and anxiety and those with pre-pandemic depression and/or anxiety. Significant differences in person-specific factors (e.g., personality, self-efficacy) were noted between the groups. Increased loneliness was also found among both those with depression or anxiety regardless of whether “new” or pre-pandemic. Finally, all those depressed or anxious reported greater disruption and distress related to the COVID-19 pandemic with a trend for increased anxiety specifically related to the pandemic (e.g., fear or dying due to COVID-19) among those with new depression or anxiety when compared to those with existing depression or anxiety, suggesting an influence of the pandemic that is specific to reports of new depression or anxiety.

Conclusion

Findings suggest increased depression, anxiety, and loneliness among individuals with MS following the COVID-19 pandemic, with reports of “new” depression or anxiety, which appears to be related to the pandemic, specifically. Moreover, factors commonly associated with depression or anxiety in MS (e.g., personality, self-efficacy) were more common among those with existing depression or anxiety but not among those experiencing new depression or anxiety. These differences should be considered when attempting to ameliorate the impact of the COVID-19 among those experiencing emotional distress.

Information-Seeking Strategies of People with Multiple Sclerosis in Spain: The INFOSEEK-MS Study

PURPOSE

Patients with multiple sclerosis (MS) are increasingly demanding access to reliable information regarding their disease. The objective of the INFOSEEK-MS study was to assess what are the strategies people with MS use when searching for information on their disease, including sources, frequency, reliability, and preferred content.

PATIENTS AND METHODS

A non-interventional, cross-sectional study was conducted. Patients with a diagnosis of MS according to the 2010 McDonald criteria were included. The InfoSeek questionnaire was used to assess patients' strategies when seeking information about the disease. Clinical characteristics and other variables, including disability, quality of life, fatigue, cognition, anxiety and depression, were analysed using the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale (MSIS-29), 5-item Modified Fatigue Scale (MFIS-5), Symbol Digit Modalities Test (SDMT), and Hospital Anxiety and Depression Scale (HADS), respectively.

RESULTS

Three hundred and two patients were studied (mean age: 42.3 ± 10 years, 64% female, mean disease duration: 9.6 ± 7.0 years, 90% with relapsing-remitting MS, and mean EDSS score: 2.6 ± 1.9). The internet (either via mobile or computer) is a frequently reported source of information. Lifestyle-related information (67.2%), research and emerging treatments (63.6%), symptom control (49.7%), sharing experiences with other patients (46.4%), and disease prognosis (46.4%) were the most searched topics. Neurologists and nurses were the most trusted source of information. Younger patients and higher SDMT scores were associated with all search resources (M = 37.7 and M = 49.97, respectively). The frequency of searches was related to the number of relapses (R² = 0.07), EDSS (R² = 0.14), MSIS-29 physical and psychological components (R² = 0.132) and inversely with depression (R² = 0.132).

CONCLUSION

Although healthcare professionals are considered the most reliable source of information for people with MS, searching for information on the Internet is very frequent. An individualized information strategy considering the different factors involved is needed.

Adverse childhood experiences predict reaction to multiple sclerosis diagnosis

Objective

At the time of multiple sclerosis (MS) diagnosis, identifying those at risk for poorer health-related quality of life and emotional well-being can be a critical consideration for treatment planning. This study aimed to test whether adverse childhood experiences predict MS patients’ health-related quality of life and emotional functioning at time of diagnosis and initial course of disease.

Methods

We recruited patients at the time of new MS diagnosis to complete self-report surveys at baseline and a one-year follow-up. Questionnaires included the Adverse Childhood Experiences (ACEs), as well as the MS Knowledge Questionnaire (MSKQ), the 36-Item Short Form Health Survey (SF-36), and Self-Management Screening (SeMaS).

Results

A total of n = 31 participants recently diagnosed with relapsing remitting MS (median EDSS = 1.0, age M = 33.84 ± 8.4 years) completed the study measures. The ACEs significantly predicted health-related quality of life (SF-36) at baseline (Adjusted R² = 0.18, p = 0.011) and follow-up (Adjusted R² = 0.12, p = 0.03), baseline scores on the SeMaS Depression scale (Adjusted R² = 0.19, p = 0.008), as well as follow-up scores on the SeMaS Anxiety (Adjusted R² = 0.19, p = 0.014) and SeMaS Depression (Adjusted R² = 0.14, p = 0.036) scales. Importantly, increased ACEs scores were predictive of increased anxiety at the one-year follow-up assessment, compared to baseline.

Conclusions

Childhood adversity predicts health-related quality of life and emotional well-being at time of MS diagnosis and over the initial course of the disease. Measured using a brief screening inventory (ACEs), routine administration may be useful for identifying patients in need of increased supportive services.

Association between self-esteem and efficacy and mental health in people with disabilities

This study aimed to investigate the association among self-evaluations-such as self-esteem and self-efficacy-self report of depression, and perceived stress among Korean individuals with disabilities. Data from the second wave of the Panel Survey of Employment for the Disabled (collected from 2016-2018) were used. In 2016 and the follow-up in 2018, 4,033 participants were included. We estimated the annual change in both independent variables and the probability of self-report of depression and stress. Generalized estimating equation model and chi-square test were used. Compared with those whose self-esteem and self-efficacy scores were ≥30, those with scores ≤19 were, respectively, 5.825 (95% Confidence Interval [CI]: 4.235-8.011; p < .0001) and 1.494 times (95% CI: 1.233-1.810; p < .0001) more likely to have self-report of depression. The perceived stress of those with self-esteem scores ≤19 or ranging from 20-24 were, respectively, 2.036 (95% CI: 1.510-2.747; p < .0001) and 1.451 times higher (95% CI: 1.269-1.659; p < .0001) than those with self-esteem scores ≥30. There exists an inverse correlation between self-evaluations, such as self-efficacy and self-esteem, and mental health in people with disabilities. The results of this study can be used as a basis for developing interventional strategies and training and intervention programs for people with disabilities. Future research is needed to investigate potential mediating factors among Korean individuals.

The Level of Stress and Coping Strategies in Patients with Multiple Sclerosis and Their Relationships with the Disease Course

Objectives: Stress is supposed to be linked with a background of multiple sclerosis (MS) and the disease course. Design: The study aimed to assess the level of stress and coping strategies in MS patients within a year of follow-up and to investigate the relationships between these aspects and factors related—or not—to MS. Methods: In 65 patients with MS, the Perceived Stress Scale (PSS-10), Type D Scale (DS14) and Coping Orientations to Problems Experienced (COPE) were performed at baseline and after a year. Baseline PSS-10, DS-14 and COPE scores were analyzed with regard to demographics, MS duration, treatment, indices of disability and self-reported stressful events (SEs). Final PSS-10 and COPE results were analyzed with reference to MS activity and SE within a year of follow-up. Results: Initially, 67% of patients reported a moderate or high level of stress and 31% met Type-D personality criteria. Diverse coping strategies were preferred, most of which were problem-focused. The negative affectivity DS-14 subscore (NEG) was correlated with disability level. Non-health-related SEs were associated with higher PSS-10 and NEG scores. After a year, the mean PSS-10 score decreased, while COPE results did not change significantly. Non-health-related SEs were associated with a higher PSS-10 score and less frequent use of acceptance and humor strategies. Those with an active vs. stable MS course during the follow-up did not differ in terms of PSS-10 and COPE results. Conclusions: MS patients experienced an increased level of stress. No significant relationships were found between stress or coping and MS course within a year. Non-health-related factors affected measures of stress more than MS-related factors.

Self-reported occupational functioning in persons with relapsing-remitting multiple sclerosis: Does personality matter?

BACKGROUND

Multiple sclerosis (MS) poses a major threat to sustainable employability. Identifying conditions and factors that promote work participation is of great importance. Our objective was to explore the contribution of personality traits in explaining occupational functioning in MS.

METHODS

241 participants with relapsing-remitting MS (78% female, median age: 42.0 years, median EDSS: 2.0) and 60 healthy controls (70% female, median age: 45.0 years) underwent neuropsychological and neurological examinations and completed questionnaires. Multivariate logistic and linear regression analyses were conducted to examine relations between personality traits and self-reported occupational functioning, while accounting for known correlates.

RESULTS

Personality traits were not associated with self-reported occupational functioning when correcting for known correlates. A higher impact of fatigue (B = -0.05, p = .005 and B = -0.04, p = .009) and depression (B = -0.22, p = .008 and B = -0.21, p = .01) were associated with no paid job (R² = 0.13) and considering to reduce work hours (R² = 0.12). A higher impact of fatigue (B = -0.05, p = .008, β = 0.46, p = .001 and β = -0.36, p = .001) was associated with absenteeism from work (R² = 0.15), more presenteeism (R² = 0.35) and lower work ability (R² = 0.25). A higher impact of fatigue (β = 0.46, p = .001) and anxiety (β = 0.25, p = .001) were associated with more work difficulties (R² = 0.54).

CONCLUSION

Personality traits did not explain additional variance in self-reported occupational functioning in persons with relapsing-remitting MS with mild disability. The impact of fatigue was the main and most consistent correlate of occupational functioning, often combined with depression or anxiety. Total explained variance of the models was limited, emphasizing the need to additionally examine other (contextual) factors when considering occupational challenges in MS.

What Biopsychosocial Factors Explain Self-management Behaviors in Multiple Sclerosis? The Role of Demographics, Cognition, Personality, and Psychosocial and Physical Functioning

OBJECTIVES

To examine the biopsychosocial correlates of overall and individual self-management behaviors in persons with multiple sclerosis (MS), including demographics, co-occurring medical diagnoses, cognition, personality traits, and psychosocial and physical functioning as variables.

DESIGN

Prospective cross-sectional cohort study.

SETTING

Community-based comprehensive MS center.

PARTICIPANTS

Adults with MS (n=112) who completed a brief neuropsychological battery that included a self-report survey and performance-based measures of cognitive function.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The MS Self-management Scale-Revised total score was the primary outcome and its 5 subscales (Healthcare Provider Relationship/Communication, Treatment Adherence/Barriers, Social/Family Support, MS Knowledge and Information, Health Maintenance Behaviors) were secondary outcomes.

RESULTS

Disease-modifying therapy usage (β=0.39), social support (β=0.31), subjective prospective memory (β=-0.25), emotional well-being (β=0.20), and histories of diabetes (β=-0.18) and high cholesterol (β=0.15) were significantly associated with overall self-management in a multivariate model. Correlates of individual self-management behaviors are also described.

CONCLUSIONS

The findings provide insights into the biopsychosocial characteristics contributing to the overall and individual self-management behaviors of persons with multiple sclerosis. The next steps will be to evaluate these factors in a clinical intervention.

Personality of patients with multiple sclerosis and the use of hippotherapy

BACKGROUND

Hippotherapy is an acknowledged form of rehabilitation for multiple sclerosis (MS) in Poland, but is still rarely used. The aim of the study was to assess the differences in the intensity of the personality traits of patients with MS who use and who do not use hippotherapy.

METHODS

The examination covered 92 patients with MS, aged 15-81 years old (85.9% women), average age 41.78 (± 15.02) years old, both using hippotherapy and not using this method of rehabilitation. The NEO-FFI Personality Inventory has been used for the study of personality traits. Socio-demographic and clinical data, as well as information regarding the use of hippotherapy, has been collected with the assistance of a self-designed survey.

RESULTS

For all of the patients, the trait expressed with the greatest intensity was conscientiousness (31 ± 7.51), and the least-expressed trait was neuroticism (24±10.42). 46% of the patients used hippotherapy and, compared to the non-users, they had a significantly greater level of agreeableness (34 v. 29, P<.001) and conscientiousness (33 v. 29, P=.009). Hippotherapy was most often used by the elderly patients (age average 49 ± 13.7, years old), while the average age of the non-users was 36 ± 13.6, years old (P<.001). Gender, education, place of residence, and economic status did not affect the choice of hippotherapy as a rehabilitation method.

CONCLUSIONS

The patients who use hippotherapy had a significantly higher level of agreeableness, conscientiousness, and openness to experience. The most important trait influencing the decision to try hippotherapy was agreeableness.

Using hypnoanalysis and guided imagery to identify and manage emotional aspects of multiple sclerosis

BACKGROUND

To date, no studies have used hypnosis to examine and manage the potential emotional causes of multiple sclerosis (MS) in the scientific field; therefore, we decided to compare the effectiveness of hypnoanalysis and guided imagery for determining and manage these emotional causes.

METHODS

Fifteen participants with severe MS were included and assigned into 2 groups: hypnoanalysis and guided imagery. In the hypnoanalysis group, the participants underwent 10 hypnotic sessions to understand events related to the cause of the disease, which were restructured (the events were modified by adding the psychological resources that each involved person needed); in addition, other techniques were used to investigate the causes and solutions according to the participants' unconscious. The guided imagery group received 10 group sessions of body relaxation and guided imagery, which were recorded for practice at home. Outcome measures, namely, disability (the Expanded Disability Status Scale, EDSS), quality of life (QoL, measured with the SF-36) and number of relapses, were evaluated 4 months previous the intervention, at baseline, post-intervention, and 3 months later.

RESULTS

Hypnoanalysis revealed that stressful events and psychoemotional maladaptive patterns acted as causal, detonating, or aggravating factors of disease, and psychoemotional changes were the most frequent and varied solutions. No changes were observed in disability between the two groups. The guided imagery group showed an improvement in 2 subscales of QoL when compared with the hypnoanalysis group (which disappeared at the follow-up); this difference is probably due to the increased number of sessions and probably due to psychoemotional maladaptive patterns being more frequently mentioned than difficult circumstances in life and/or unsolved past events. However, the techniques used in hypnoanalysis were effective in understanding the potential emotional causes of MS, which showed high intra- and inter-participant consistency.

CONCLUSIONS

The daily use of guided imagery overcame the restructuring of negative past events to improve QoL in patients with MS.

TRIAL REGISTRATION

ACTRN12618002024224 (retrospectively registered).

How personality traits affect functional outcomes in patients with multiple sclerosis: A scoping review on a poorly understood topic

Personality is an important variable when explaining individual differences in disease acceptance, coping styles and psychological well-being. Personality changes, such as social inadequacy, disinhibition, apathy, emotional lability, and impulsivity, have been reported in many patients with multiple sclerosis (MS). This review sought to assess the role of personality traits in people with MS, focusing on how this may affect the patient's outcome. Studies were identified by searching on PubMed, Web Of Science and Cochrane databases. Our review shows that the personality traits commonly found in MS are often dysfunctional. In particular, it has been suggested that people with MS present with lower levels of conscientiousness, extraversion and agreeableness, as well as higher levels of neuroticism than healthy controls. These personality traits negatively affect cognitive domains, mood, and psychological well-being. As personality may affect the clinical manifestations and disabilities of patients with MS, personality assessment should be an integral part of the management of the disease, in order to achieve better functional outcomes.

Type D personality and life event stress: the mediating effects of social support and negative social relationships

Background and Objective: Type D personality has been associated with increased perceptions of stress. As Type D individuals have been noted to report lower social support and greater perceptions of negativity in social interactions, this study examined if the association between Type D personality and life events stress was mediated by these social relationships. Design: A cross-sectional design. Methods: Undergraduate students (N = 197) completed questionnaires assessing Type D personality, social support, negative social relationships, and life events stress. Results: Unadjusted analyses revealed that Type D individuals perceived their life events to be significantly more stressful than non-Type D individuals. Type D individuals also reported increased perceptions of negative social relationships and lower social support. Finally, the association between Type D personality and life events stress was mediated by perceptions of negative social relationships. However, when controlling for the main effects of negative affectivity and social inhibition, Type D was not significantly associated with social relationship or life events variables. Further, effects appeared to be primarily driven by negative affectivity. Conclusion: These results support recent findings in the Type D literature that have identified null effects of Type D when controlling for negative affectivity.

The use of generic avoidant coping scales for psychosocial adaptation to chronic illness and disability: A systematic review

This systematic review examined the validity of generic coping-with-stress measures in the relationships between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Major data bases were searched for studies on the association between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Findings indicated that reliance upon avoidance-type coping is linked to reports of poorer psychosocial adaptation. The veracity of these findings must be treated cautiously owing to conceptual, structural, psychometric, and other issues. Users of generic coping measures should consider these concerns prior to empirically investigating the link between generic avoidance-type coping measures and psychosocial adaptation among people with chronic illness and disability.

Biopsychosocial model of resilience in young adults with multiple sclerosis (BPS-ARMS): an observational study protocol exploring psychological reactions early after diagnosis

INTRODUCTION

Multiple sclerosis (MS), the most common neurological disease causing disability in young adults, is widely recognised as a major stress factor. Studies have shown that the first years after the diagnosis are distressing in terms of adjustment to the disease and that MS negatively affects patients' psychological well-being, quality of life (QoL) and social functioning. However, the links between disease-specific variables at diagnosis, resilience and psychological adjustment of patients with MS remain largely unexplored, especially in adolescents and young adults. This observational study aims to fill the gap of knowledge on biopsychosocial characteristics and resilience of young adults with MS to evaluate the relationship among these variables and to develop a biopsychosocial model of resilience.

METHODS AND ANALYSIS

Biological and clinical characteristics of young adults newly diagnosed with MS will be investigated by collecting clinical information, performing neurological examinations, MRI and analysing cerebrospinal fluid and blood biomarkers (eg, measures of inflammation), body composition, gut microbiota and movement/perceptual markers. Psychosocial characteristics (eg, psychological distress, coping strategies), QoL, psychological well-being and resilience will be assessed by self-report questionnaires. Comparative statistics (ie, analysis of variance or unpaired samples t-test, correlation and regression analyses) will be applied to evaluate the relationship among biological, psychological and social factors. The results are expected to allow a comprehensive understanding of the determinants of resilience in young patients with MS and to inform resilience interventions, tailored to young patients' specific needs, aiming to reduce the risk of maladaptive reactions to the disease and to improve psychological well-being and QoL.

ETHICS AND DISSEMINATION

The study has been approved by the Verona University Hospital Ethics Committee (approval number: 2029CESC). The findings will be disseminated through scientific publications in peer-reviewed journals, conference presentations, social media and specific websites.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (NCT03825055).

Factors associated with disease self-efficacy in individuals aging with a disability

Self-management of a disability consists of treatment adherence, obtaining information about the disease and treatment options, caring for oneself, participating in decisions, and maintaining social relationships and emotional balance. Understanding and measuring an individual's beliefs about their ability to successfully self-manage and live well with a disability allows researchers and clinicians to better target interventions aimed at increasing disability management self-efficacy (DMSE). The purpose of this study was to examine the associations between demographic and clinical indicators, and self-efficacy for DMSE in individuals with chronic physical conditions. Adults (N = 815) with muscular dystrophy, multiple sclerosis, spinal cord injury, or post-polio syndrome completed a self-report mailed survey assessing DMSE, perceived social support, depression symptoms, resilience, fatigue, pain interference, satisfaction with participation in social roles, physical function, and demographics. A cross-sectional regression model was used to examine the associations between the clinical and demographic factors, and DMSE. The model explained 67% of the variance in DMSE. Satisfaction with participation in social roles, resilience, pain interference, social support, and fatigue were statistically significant. Better social functioning, more resilience, and less pain and fatigue were most strongly associated with DMSE. Interventions aimed at increasing DMSE should include strategies for improving social participation.

Identifying risk factors for cognitive issues in multiple sclerosis

INTRODUCTION

Cognitive impairment (CI) in Multiple Sclerosis (MS) has progressively regained clinical and research interest and is currently recognized as a debilitating and burdensome problem for these patients. Studying risk and protecting factors that may influence the development and course of CI is currently an area of increasing interest, due to the potential for preventive strategies. Areas covered: In this narrative review the authors briefly addressed the physiopathologic basis, assessment and management of CI in MS and then focused on identifying modifiable and not modifiable risk factors for CI in MS, providing an overview of the current knowledge in the field and indicating avenues for future research. Expert opinion: Improving our understanding of potentially modifiable environmental and lifestyle risk factors or protective factors for CI is important in order to prompt preventive strategies and orient patient counselling and clinical management. To this aim, we need to enhance the current level of evidence linking lifestyle factors to cognition and evaluate some factors that were only preliminary addressed in research. Moreover, we need to explore the role of each factor into the subject cognitive outcome, next to the possible interactions between different environmental factors as well as between environmental and genetic factors.

Health-related outcomes, health care resource utilization, and costs of multiple sclerosis in Japan compared with US and five EU countries

Purpose

Multiple sclerosis (MS) imposes a huge burden on patients. This study examined the relationship between MS and health-related and economic burden in Japan; secondarily, health status was compared across patients with MS in Japan, US, and five European Union (5EU) countries (France, Germany, Italy, Spain, and UK).

Methods

A retrospective cross-sectional study was conducted using self-reported data from 2009 to 2014 Japan National Health and Wellness Survey (n=145,759). Health status, work productivity loss, activity impairment, health care resource utilization, and annual costs associated with MS (n=85) were compared with controls without MS (n=145,674). Propensity score matching and multivariable linear regressions determined the effect of MS after controlling for confounders. Health status in Japan was also compared with that of 5EU (n=62) and US (n=67) patients with MS.

Results

Patients with MS in Japan reported significantly worse health status via mental component summary score (MCS; 40.1 vs 45.8) and physical component summary score (PCS; 41.4 vs 51.2) and health state utility scores (0.63 vs 0.74; all P<0.001). They also reported more absenteeism (12.0% vs 3.7%), presenteeism (33.8% vs 19.8%), overall work impairment (40.9% vs 21.6%), and activity impairment (43.6% vs 24.0%), with higher indirect costs (¥2,040,672/US $20,102 vs ¥1,076,306/US$10,603) than controls (all P<0.001). Patients with MS reported higher resource use, including provider visits (8.0 vs 4.7), emergency room visits (0.03 vs 0.1), and hospitalizations (2.7 vs 0.69) in the past 6 months, with higher direct costs (¥3,670,906/US$36,162 vs ¥986,099/US$9,714) than controls (all P<0.001). Finally, Japanese patients with MS reported lower MCSs and higher PCSs than their US and 5EU counterparts.

Conclusion

MS in Japan is associated with poor health status and high work productivity loss, resource use, and costs, underscoring the need for improved treatment, especially vis-à-vis mental health, when comparing Japanese patients with their 5EU and US counterparts.

Quality of life and psychological well-being in the early stages of multiple sclerosis (MS): Importance of adopting a biopsychosocial model

BACKGROUND

Reductions in quality of life (QOL) exist among individuals with multiple sclerosis (MS).

OBJECTIVE

The present investigation aimed to adopt a biopsychosocial model in examining QOL in the early stages of MS.

METHODS

Individuals with MS (34 with average to low QOL and 35 with high QOL) were compared on measures of disease symptoms, psychological functioning, personality, self-efficacy, locus of control (LOC), social support, and coping to determine the most salient predictors of QOL.

RESULTS

Individuals were matched on disease course and duration. Individuals with lower QOL reported more fatigue, sleep problems, pain, depression, and anxiety (d = 0.83-1.49, p's < 0.001). They also reported lower levels of self-efficacy, LOC, and social support (d = 0.75-1.50 p's < 0.01). They indicated higher levels of neuroticism (d = 1.31, p < .001) and lower levels of extraversion (d = 1.21, p < .001) and reported greater levels of disengagement as a means of coping (d = 0.75, p = .002). Those with high QOL endorsed more use of adaptive coping (d = 0.52 - 0.86, p's < 0.05). When taken together, LOC and anxiety were the most significant predictors, accounting for 40% of the variance.

CONCLUSION

Even early on in the illness, there exists differing levels of QOL. Identifying the psychological and social variables as well as the disease related factors is important, and in this case, may make a much greater contribution. Efforts to assure routine assessment and effective intervention aimed at these factors are warranted, particularly as an early intervention to assure maintenance/improvement in QOL among individuals with MS.

White matter tract network disruption explains reduced conscientiousness in multiple sclerosis

Quantifying white matter (WM) tract disruption in people with multiple sclerosis (PwMS) provides a novel means for investigating the relationship between defective network connectivity and clinical markers. PwMS exhibit perturbations in personality, where decreased Conscientiousness is particularly prominent. This trait deficit influences disease trajectory and functional outcomes such as work capacity. We aimed to identify patterns of WM tract disruption related to decreased Conscientiousness in PwMS. Personality assessment and brain MRI were obtained in 133 PwMS and 49 age- and sex-matched healthy controls (HC). Lesion maps were applied to determine the severity of WM tract disruption between pairs of gray matter regions. Next, the Network-Based-Statistics tool was applied to identify structural networks whose disruption negatively correlates with Conscientiousness. Finally, to determine whether these networks explain unique variance above conventional MRI measures and cognition, regression models were applied controlling for age, sex, brain volume, T2-lesion volume, and cognition. Relative to HCs, PwMS exhibited lower Conscientiousness and slowed cognitive processing speed (p = .025, p = .006). Lower Conscientiousness in PwMS was significantly associated with WM tract disruption between frontal, frontal-parietal, and frontal-cingulate pathways in the left (p = .02) and right (p = .01) hemisphere. The mean disruption of these pathways explained unique additive variance in Conscientiousness, after accounting for conventional MRI markers of pathology and cognition (ΔR²  = .049, p = .029). Damage to WM tracts between frontal, frontal-parietal, and frontal-cingulate cortical regions is significantly correlated with reduced Conscientiousness in PwMS. Tract disruption within these networks explains decreased Conscientiousness observed in PwMS as compared with HCs.

Effect of Mindfulness Meditation on Personality and Psychological Well-being in Patients with Multiple Sclerosis

BACKGROUND

Varied evidence shows that mindfulness-oriented meditation improves individuals' mental health, positively influencing practitioners' personality profiles as well. A limited number of studies are beginning to show that this type of meditation may also be a helpful therapeutic option for persons with multiple sclerosis (MS).

METHODS

We evaluated the effects of an 8-week mindfulness-oriented meditation training on the personality profiles, anxiety and depression symptoms, and mindfulness skills of a group of patients with MS. A control group of patients with MS not enrolled in any training was also tested.

RESULTS

After mindfulness-oriented meditation training, participants in this group (n = 15) showed an increase in character traits reflecting the maturity of the self at the intrapersonal (self-directedness) and interpersonal (cooperativeness) levels. Moreover, increased mindfulness and conscientiousness and decreased trait anxiety were observed in participants after the training.

CONCLUSIONS

These data support the utility for patients with MS of therapeutic interventions based on mindfulness meditation that may lead to enhanced character and self-maturity.

Cognitive-constructivist Approach in Medical Settings: The Use of Personal Meaning Questionnaire for Neurological Patients' Personality Investigation

Objective: The cognitive-constructivist psychotherapy approach considers the self as a continuous regulation process between present and past experience, in which attributions of meaning is characterized by the use of internal rules. In this conception, everyone would be driven by a specific inner coherence called Personal Meaning Organization (PMO). Such approach has never been applied to neurological patients by means of ad hoc developed tools. We performed an explorative study aimed to characterize personality styles in different neurological conditions within the theoretical framework of cognitive-constructivist model.

Materials and Methods: Three groups of neurological patients (Amyotrophic Lateral Sclerosis, Multiple Sclerosis, Primary Headache) and a sample of healthy participants, each composed by 15 participants, for a total of 60 participants, were recruited. The Personal Meaning Questionnaire (PMQ), an Italian questionnaire assessing PMOs construct, and other clinical tools for psychological and quality of life assessment were administered to all subjects.

Results: The main finding concerned the detection, across all clinical conditions, of a higher prevalence of phobic personality style, with Amyotrophic Lateral Sclerosis showing a relevant prevalence of such PMO with respect to all other neurological conditions and controls. However, with respect to controls, in all clinical conditions, PMQ highlighted a tendency, even if not statistically significant, to codify experience by means of specific cognitive and emotional patterns.

Conclusion: Our findings represent the first contribution towards understanding the personality profiles of patients affected by neurological conditions according to cognitive-constructivist theory.

Trait neuroticism, extraversion, and conscientiousness in multiple sclerosis: Link to cognitive impairment?

Background:

Previous research suggests that patients with multiple sclerosis (MS) have higher neuroticism, lower extraversion, and lower conscientiousness relative to healthy controls (HCs). However, the prevalence of this maladaptive profile in MS and its relation to cognition is unknown.

Objective:

Determine prevalence of maladaptive personality among MS patients, compared to HCs, and examine how it relates to cognitive dysfunction.

Methods:

A sample of 275 MS patients and 55 HCs completed neuroperformance measures of information processing speed and memory. Self and informant ratings were obtained on the NEO Five-Factor Inventory.

Results:

MS patients had higher neuroticism and lower extraversion than HCs. Cognitively impaired patients were also lower in conscientiousness. Cluster analysis revealed a configuration of these same three traits, representing a maladaptive profile. This profile was found in 50% of the overall MS sample, compared to 24% of HCs. However, only cognitively impaired MS patients had a higher prevalence of maladaptive personality compared to HCs. Among cognitively impaired patients, those with maladaptive traits were impaired in more cognitive domains than those with more adaptive traits.

Conclusion:

Cognitively impaired MS patients have a higher prevalence of seemingly maladaptive traits compared to HCs, demonstrating an association between cognition and personality in MS.

Lifestyle, medication and socio-demographic determinants of mental and physical health-related quality of life in people with multiple sclerosis

Background

Health-related quality of life (QOL) is a key outcome for people with multiple sclerosis (MS). While modifiable lifestyle factors, like smoking, physical activity and vitamin D, have strong associations with development and progression of MS, few studies have examined such associations with QOL.

Methods

Using patient-reported data from 2312 people with MS from 54 countries, regression models explored associations of socio-demographic, therapeutic and lifestyle factors with QOL, using the Multiple Sclerosis Quality of Life-54 (MSQOL-54).

Results

Participants were on average 45.6 years old, 82.4% women, mostly partnered (74.1%), with a university degree (59.5%). Controlling for socio-demographic factors and disability, factors associated with better physical health composite (PHC) (on a 100 point scale) were: moderate and high physical activity compared to low (5.9 [95% confidence interval: 4.2, 7.6] and 9.9 [CI: 8.1, 11.6] points higher score respectively); non-smoking compared to current smoking (4.6 points [CI: 2.4, 6.7]); better diet (per 10 points on the 100 point Diet Habits Questionnaire scale (DHQ) 1.6 points [CI: 1.0, 2.2] points); normal body mass index (BMI) versus overweight or obese (2.1 points [CI: 0.4, 3.7] and 2.4 points [CI: 0.5, 4.3]); fewer comorbidities (4.4 points [CI: 3.9, 4.9]); and not taking a disease-modifying drug (DMD) (2.1 points [CI: 0.7, 3.4]).

Better mental health composite (MHC) determinants were: moderate and high physical activity compared to low (4.0 points [CI: 2.0, 6.0] and 5.7 points [CI: 3.5, 8.0]); non-smoking compared to current (6.7 points [CI: 4.1, 9.3]); better diet (2.8 points [CI: 1.9, 3.5]); normal BMI versus overweight or obese (3.1 points [CI: 1.1, 5.1] and 3.5 points [CI: 1.3, 5.7]); meditating regularly (2.2 points [CI: 0.2, 4.2]); and no DMD use (2.9 points [CI: 1.3, 4.6]).

Conclusions

While causality cannot be concluded from cross-sectional data, the associations between modifiable lifestyle factors and QOL suggest significant potential for secondary prevention of the known deterioration of QOL for people with MS through lifestyle risk factor modification.

Electronic supplementary material

The online version of this article (doi:10.1186/s12883-016-0763-4) contains supplementary material, which is available to authorized users.